Human Limits

Exploring performance and health with Michael J. Joyner, M.D.

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Archive for October, 2012

Baby Its Cold Outside

Today’s post is about how to get the most out of your indoor training.   My motivation is that up here in Minnesota more people will be doing more of their exercising indoors in the winter months.   I am not sure when the shift begins but I hear from studio cycling instructors that class size starts to pick up in October and remains high until March or April.

In the pre-gym, fitness center, and indoor exercise equipment era a few brave souls went outside to run “no-matter what”.   The advent of better protective clothing in the 1980s helped, and I can remember putting titanium screws on the bottoms of old running shoes to improve footing and grip on the ice.  Equipment and clothing for outdoor exercise have gotten better but thankfully I have gotten less macho and am now happy to be indoors most days during the “deep winter” or even the “deep fall”.

In previous posts I talked about the value of interval training for all and also provided some ideas about how to get the most out of your training as you age.  In this post I want to give you some ideas about good ways to maintain your fitness indoors based on what has been described as the “Hickson Protocol”.   It comes from a 1977 paper called “Linear increase in aerobic power induced by a strenuous program of endurance exercise.” 


What is the Hickson Protocol?
The protocol consists of exercise 6 days per week for 10 weeks.   On days 1,3, and 5 the workout is six 5-minutes maximal cycling intervals separated by 2-minutes of easy cycling. On the alternate 2,4, and 6 it is 40 minutes of hard running.  The figure below shows that when untrained subjects first used the protocol they achieved vast increases in maximal oxygen consumption (VO2 max) over the course of the 10 weeks of training.


Who wants to train this hard every day forever?
The short answer is not many people and when the original 8 subjects were offered the chance to continue beyond the original 10 weeks they all said no!   However, this study does show just what is possible with hard training.


How can I use this data to plan my winter training?
Most people reading this probably already exercise and some of you are competitive athletes and already do at least some high intensity training.   Hickson can help us here.  He did a number of similar training studies and then asked people to reduce their training frequency, duration, or intensity in various ways to see just how much (or how little) exercise was required to maintain VO2 max at a high level.  He ultimately showed that brief periods of intense training a few times per week were remarkably effective in maintaining VO2 max at a high level.


“We conclude that it is possible to maintain almost all of the performance increases with up to a two-thirds reduction of training duration. Nevertheless, the data provide initial evidence that all aspects of the endurance-trained state may not be regulated uniformly in reduced training, particularly since VO2 max and short-term endurance were maintained, but long-term endurance decreased in the 13-min group.”


Summing up.
Clearly there is more to training and competing successfully than doing intense exercise just a few times per week for a few minutes.  However, the winter is a time when many people do a little less and the Hickson studies show that if you do a bit of high intensity exercise every week it will be easier to gear up when the weather gets better and the days get longer.   The Hickson data is also helpful for planning your training when you are traveling or have limited training time.   You can clearly accomplish a lot with 30-45 minutes per day of training, and maintain things with even less.


Innovation, Doping and Dollars

I want to use this post to present an off-beat assessment on some of the lesser discussed implications stemming from the “decline and fall” of Lance Armstrong who was stripped of his seven Tour de France wins earlier in the week.   Here are some thoughts:

First, Lance had a history of using what might be described as strong arm or aggressive tactics with his perceived “enemies” and subordinates.   So, as more people started to come forward there were all sorts of people willing to share their stories.   A number of years ago I commented in a story on doping in baseball that many hyper competitive elite athletes were a bit sociopathic and that certainly appears to apply to Lance if half of what we are hearing is true.

Second, it has been known for some time by the scientific community that there were a lot of technical holes in the drug testing protocols.   When my colleague Carsten Lundby pointed that the EPO test was “beatable” in 2008 he was vilified by the doping control establishment.   It turns out Carsten was right and he has issued new warnings about the biological passport approach.   I wonder if the authorities will listen to him this time.  He has some good ideas about what to do next.

Third, I had the chance to work with the late Dr. Jim Lipsky who was a leader in Clinical Pharmacology.   Jim could be critical of the pharmaceutical industry, but always pointed out that there was a lot more innovation and development of new compounds via capitalism in comparison to what came from communist countries behind the old Iron Curtain.   I think this also applies to sports doping.   The state sponsored program in East Germany was thorough and comprehensive but it was mostly the same old drugs given to large number of unsuspecting athletes (many of them very young) in a highly organized way.    By contrast, team Lance appears to have developed a number of novel ways to administer low dose EPO to avoid detection and use combinations of autologous transfusions (blood doping) and EPO to avoid detection.   They also seemed to have pretty good ideas about how long they would test positive after taking EPO or steroids and developed clever dosing schemes and other ways to avoid testing.    Designer steroids that are difficult to detect are also products of black or perhaps grey market capitalism associated with sports doping and creative but rogue chemists like Patrick Arnold.   The fact that there is serious money in sports doping is demonstrated by allegations of about 30 million dollars of money laundering that center around Michele Ferrari, the physician in the middle of the Armstrong scandal.  All of this suggests there is a pretty strong link between dollars and innovation in sports doping.

In summary, the ethical issues aside and ignoring the idea that perhaps there is a level playing field because “everyone is doping”, it is pretty clear that the people involved in sports doping are plenty smart and creative.  One of the sad side stories in all of this is that people like Patrick Arnold could have been devising novel drugs to treat patients and alleviate suffering vs. creating designer steroids.    Likewise, Michele Ferrari could have used his intellect and organizational skills to help the world get fitter instead of going to the dark side of professional sport.


Running Fast While Getting Older

I got an e-mail over the weekend from a reader who was a world class runner in his youth and getting ready for an upcoming half marathon.


“Michael: I seem to have hit that mid-60s point where things deflect a little on the difficulty/slower-speed curve. Trying to stay positive…..”


That having been said, I was thinking about doing a post on the lack of discussion in the election about the real problems confronting health care in the United States.  Most of the yapping seems to be about how various insurance programs might be organized and misses the fundamental point that if things don’t change the combination of inactivity, obesity and aging is generating a tidal wave of chronic diseases that will bankrupt anything that is being discussed.    However, the aging and speed curve issue raised by the reader above is more fun and there are some pretty simple ways to address it.


First, what is meant by the “slower-speed curve”?  If you plot records vs. age for almost any distance running event you get a graph like the one below.   I did this one 20 years ago for a scientific review on aging and endurance performance and it plots age vs the US record for 10K road race time.   The times have changed since then but the trends are pretty similar.  (If any enterprising student who might be reading this wants to update the curves let me know and we can set up a guest post on the topic.)



You can see that times are best for competitors from their early 20s until the middle or later 30s.   After the late 30s, things decline at a rate of about 6% per decade and the rate of decline increases somewhere in the 60s for men.   The data for women is similar but a little harder to interpret because we have not seen the full effects of Title IX and increased participation by women on the age group records.   While this data is for record performances by many different runners, many individuals report similar personal experiences and note, as the reader did, that something happens in their 60s.


Second, what happens in your 60s?  There are several possibilities.  From a biological perspective, things like peak heart rate decline as we age, but the rate of decline does not accelerate in your 60s.  That having been said, something called sarcopenia (age related muscle loss) probably starts to accelerate in the 60s.   If you look at people who tend to maintain their performance over time, there is evidence in men that those who decline the least keep their lean muscle mass and training intensity up.   In women it appears to have more to do with training volume (milage) and hormone replacement therapy.   However, I want to point out again that less is known about female master athletes, and there is some evidence that in terms of training intensity, what applies to men applies to women as well.   Here is a link to an article on Kathy Martin who is rewriting the record books for older women.  Note that she does a lot of high intensity training and my understanding is that she has added milage only recently with her move up to the marathon.

The other issue here is that injuries and other health issues catch up with people as they get older and perhaps it is just harder for most folks to train as consistently and consistently hard for these reasons.


Third, can you beat the speed curve?  My personal opinion based on a combination of observations, discussions with others, and a tiny bit of research driven evidence is that training quality is the key.   I would advocate that in your 50s and 60s you might cut your milage back and do most of what we used to call “over-distance” training on the bike or in the pool.  This will let you focus your running on higher quality efforts and provide a lot of bang for the buck with minimal orthopedic risk.   An interesting anecdote is that in the early 1990s the legendary Fred Wilt, a world record holder in the 1940s, told me that when he was in his 50s he came close to breaking 10 minutes for 2-mile.   His training consisted of jogging a few minutes mile to a track near his home and doing two miles of alternating fast and slow 200m runs very hard and then jogging home.  He did this about 4-5 days per week.

Consistent with what Fred Wilt was doing in his 50s, he documented in several books the training used by athletes who ran some pretty incredible times prior to the “modern” ideas about training emerged after World War II.  Much of it seemed to consist of things like 4-5 miles of hard running followed by some all out sprints 4-5 days per week.   I personally try to do something like this 2-3 times per week, and sometimes do the sprints on the bike trainer to keep the risk of injury to a minimum.   The other thing I like to do is 20-30 minutes of hard steady riding on a trainer followed by 20 minutes of 1-minute on/off of fast-slow running.   The advantage of using a treadmill and bike trainer to do this type of training is that it may be a bit easier to push yourself.  I am 54 and following this plan as I prepare for a 5 mile Turkey Trot on Thanksgiving.


Fourth, why will this work?  In an earlier post on distance running and the Olympics this summer I covered the concept of VO2 max and its role in setting the upper limit for endurance performance.  The type of intense training discussed above and very hard efforts of 3-5 minutes are the keys to keeping your VO2 max as high as possible while you age.   I also think that biking vs over distance running is a good way to keep your muscle mass up.   I am always impressed at how the best master athlete cyclists and swimmers seem to have maintained their muscle mass in comparison to distance runners who sometimes look a little wasted.


Summary:  The ideas above represent my best guesses about how to maintain a high level of performance especially in your later 50s and 60s.  They are designed to limit the risk of injury.  There is scientific evidence for most of these ideas and there are real world examples showing that these ideas work.   We all eventually lose the battle with aging; the key is to lose it slowly by walking, running, biking, or swimming fast.


Will Lance have a “Second Act”?

In response to the drop Lance Armstrong as fast as you can movement by his sponsors and his resignation as chairman from his foundation one reader sent me a note that went like this:

”He is finished – might as well move to his house in Spain and not come back.”

 I am not sure if Lance has a house in Spain, but I think we all get the point.   At one level perhaps he should try to preserve as much of his reported $125 million fortune as possible, keep a low profile and hope that he does not drown in a tidal wave of lawsuits and settlements.

So, the question is will Lance have a second act?  F. Scott Fitzgerald famously said that there “are no second acts in American lives.”   Lance was trying to forge one in the triathlon, but he was cut off at the pass by USADA in terms of competing at the highest level.  So what is next?  One crazy thought I had is that maybe Lance will “come clean”, write a block buster book, name names, and set the record straight (at least from his perspective).   Who knows he might even find religion?

If something like this does happen, he would not be the first fallen public figure to cash in that way.   To the extent he is driven by the need for fame, celebrity, and cash this might be his best option.  To the extent he needs to be driving the narrative, perhaps it is his only option.   If Lance fades away so be it.  If he opts for the second life I have outlined it will be a nine ring circus.


Doping: A Reading List

I mentioned on Monday that I was at the Integrative Biology of Exercise meeting last week.   One of the topics of hallway conversation was the release of the USADA report on Lance Armstrong and the rampant doping in Cycling during the time he won seven Tour de France races in a row.   It turns out that one of the most popular books my colleagues and I were reading on the plane to the meeting was “The Secret Race” by Tyler Hamilton and Daniel Coyle.  Hamilton was one of the world class cyclists who spilled the beans to USADA.

I discussed the ”geopolitics” of Lance situation in detail last summer, but the Hamilton book gives a broader perspective on the problem of doping.   It describes in detail how an earnest and ambitious young athlete gets into the highest level of cycling.   How the super talented find themselves in the middle of the pack.   How a moment or a few moments of truth occur and it is either continue to chase your dreams and dope, or go home and join the real world.   The decision to dope is of course made easier if everyone is doing it,  and who can expect the super competitive to simply unilaterally disarm and simply give up.  The book also describes how it was relatively easy to beat drug testing with a little bit of planning, corrupt doctors, and cash.

As I read to the book I thought back to the time to the late 1970s when I was sometimes running 100 miles per week or more.   Prior to my personal best marathon I ran 522 miles in four weeks before tapering.  Essentially my entire life revolved around training, all my friends and peers were runners, and I was certainly willing to pay a big price to improve.  My only distraction was going to class.   That having been said I wonder if I had been in a corrupt culture with corrupt coaches and big money on the line if I would have doped?    If everyone is doing it, is it really wrong?  I hope I would have said no, but who knows.

As things have emerged over the years it is also pretty obvious that we live in an ergogenic world full of plastic surgery, Botox, Viagra, doping to improve grades, and various anti-aging potions.    Is everyone looking for success in a bottle, a pill, or via a syringe?   Why should elite sport be different than the rest of the world?

That having been said, I recommend two other books for those who want to understand more about doping.   The first is “Game of Shadows” from 2007.  This book details the Barry Bonds case and the BALCO scandal.   In addition to exploring the logistics of sports doping and what motivates athletes to dope, the book raises important questions about what the “authorities” who oversee sports leagues and organizations really want.   Are they concerned with clean competition?   Or, is about brand protection and the appearance of clean competition so that sponsors and general public don’t turn away if things look too overtly corrupt?  Yesterday Lance Armstrong lost most of his major sponsors and stepped down as chairman of his foundation.   Were these acts of organizations interested in doing the right thing or brand protection?

The second book is “Muscle: Confessions of an Unlikely Bodybuilder” by Sam Fussell.  Fussell was essentially a “95 pound” weakling/intellectual with degrees from several top universities who got involved in bodybuilding and went all in.   The book describes how it is possible for an otherwise thoughtful and intelligent person to descend into an athletic subculture and do just about anything to improve.   It is a cult classic, and I highly recommend it.



3 Weeks = 30 Years!

Last week I had the opportunity to attend the “Integrative Biology of Exercise” conference sponsored by the American Physiological Society.   During an excellent talk on how exercise training can modify the changes in heart function with age, Dr. Ben Levine showed classic data from a study done in the middle 1960s known as the Dallas Bed Rest Study.

In this study 5 healthy young men did nothing but bed rest for three weeks while detailed measurements of their cardiovascular function and exercise capacity were measured.    Not surprisingly, cardiac function declined and exercise capacity fell dramatically with bed rest.   The figure below shows what happened to VO2 max which is considered the gold standard measurement of exercise capacity after bed rest.



What is even more interesting about this figure is that when the same subjects were studied 30 years after the original bed rest study, their VO2 max fell more with just three weeks of bed rest than with 30 years of aging.   Below is a video link of Dr. Levine talking about his work on related topics.


 If video does not load, click here.


Another interesting video on the topic of inactivity comes from Dr. Bente Pedersen of the University of Copenhagen.    Her team has conducted an incredible study showing that just two weeks of minimal physical activity can put previously health young men on the path to what might be described as pre-diabetes.    In the video below she discusses these findings and also concepts related to the fit vs. fat topic covered a few posts ago.


If video does not load, click here.


These are terrific talks by scientific leaders who are my friends and colleagues.  One of the great things about the electronic environment is that presentations by such outstanding investigators are available to us all.


Making Football Safer?

There has been a lot of talk recently about the long term health risks associated with U.S. football.  There are two main concerns, the first relates to the long term effects of concussions and cognitive impairment later in life.  The second relates to the long term health risks associated with being “very big”.

It turns out that the neurological consequences of football are more typically seen in so-called speed positions that are associated with high velocity open field “big hits” in comparison to collision positions like the line.   The non-neurological long term health risks of professional football go something like this:


“National Football League players from the 1959 through 1988 seasons had decreased overall mortality but those with a playing-time BMI ≥ 30 had 2 times the risk of CVD mortality compared to other players and African-American players and defensive linemen had higher CVD mortality compared to other players even after adjusting for playing-time BMI.”


Some of these concerns were highlighted in a piece by the columnist George Will who summarized it this way:


“Decades ago, this column lightheartedly called football a mistake because it combines two of the worst features of American life — violence, punctuated by committee meetings, which football calls huddles. Now, however, accumulating evidence about new understandings of the human body — the brain, especially, but not exclusively — compel the conclusion that football is a mistake because the body is not built to absorb, and cannot be adequately modified by training or protected by equipment to absorb, the game’s kinetic energies.”



The first thing to remember is that the modern game of football emerged after deaths in college football in the early 1900s led President Theodore Roosevelt to demand that the game be reformed or banned.  So, the safety of football is not a new issue and in that spirit I make the following suggestions:

  1. Limit substitutions.   If players had to play both ways my bet is that the premium on very large players (300 pounders) would be replaced by a premium on big but not huge players who had the athletic skills to do more than one thing and also the stamina to play for longer.   When teams go to no huddle offenses frequently their defenses complain about the lack of rest caused by an offense that gets off the field too fast.  So, there would be a new emphasis on conditioning.
  2. Shorten the time between plays.  If there were a 20 second clock between plays the game would be more continuous and that would make conditioning even more important and limit the utility of really big players.  It might also limit the likelihood of pre-planned, high speed big hits.
  3. Get rid of some of the protective equipment.    It is unclear if the protective equipment is in fact that protective.  Perhaps it gives the players a false sense of security and encourages them engage in high risk, high impact hits.

Some of the ideas above would make U.S. football more like rugby so I bounced them off four outstanding physiologists from rugby loving countries:  Danny Green and Bob Callister from Australia, Tim Noakes from South Africa, and Peter Raven originally from the UK.    All of my colleagues agreed the ideas above had merit.    Dr. Green sent me a fascinating paper about body size in rugby and how it has changed over the last 100 year, and it is unusual for a top class rugby player to be much bigger than 110kg (about 245 lbs).

In closing, I doubt the ideas above will ever be adopted wholesale, but various forms of football have existed for centuries and perhaps the game will evolve in the ways I have outlined above.  If so, I bet we will end up with a safer game to play and watch that is equally exiting.  Watch a clip of the 7 on 7 version of rugby that will be coming to the Olympics in 2016 and see wide open game.   Add the forward pass and imagine what would be possible.



Fit vs Fat?

I got an e-mail a couple of days ago from a friend and reader who is world-class engineer/leader for a large company who just returned to the US after several years on an overseas assignment.   Here is an extract from the message:


“I read the blogs for the past month, very interesting.  There was a lot of coverage of obesity…….something I know firsthand, all too well, unfortunately.  You’d think I’d listen to such good advice and make some changes.  But, as you say, it is a complex issue.  I hope that just one poor risk factor out of six, will not be too bad.”


This got me thinking about the whole obesity issue and perhaps it is time to stress some good news.  That having been said, there is pretty convincing evidence that remaining fit and active can trump a lot of the negative health risks associated with obesity.   The graph below shows the relative risk (RR) for all-cause mortality (top panel) and cardiovascular disease (CVD) mortality (bottom panel) in lean, normal and obese subjects.  The dark bars are for unfit people and open bars for fit people.  The study comes from the Cooper Center database and included almost 22,000 men.   The numbers of above the bars are numbers of deaths in each group over a multi-year period of observation.



The dark bars show that obesity puts people at increased risk for both all-cause mortality and cardiovascular disease.   This increased risk is clearly amplified by being unfit.   By contrast, all-cause mortality was lower in the fit people and the amplifying effects of excess body weight were much less.  There are all sorts of reasons why being fit and active can trump other risk factors like obesity; less diabetes, blood vessels that can stay relaxed, and better blood pressure control to name a few.   The other issue here is that people need to avoid getting hung up on losing a set amount of weight to reach an “ideal”.    Losing just 5 or 10 pounds can really make a difference in a number of risk factors and is especially effective if it is accompanied by more physical activity.

So here is an encouraging thought from a recent study for people who worry about their weight:


“Higher fitness should be considered a characteristic of metabolically healthy but obese phenotype. (ii) Once fitness is accounted for, the metabolically healthy but obese phenotype is a benign condition, with a better prognosis for mortality and morbidity than metabolically abnormal obese individuals.”


Or as Dr. Chip Lavie, a noted cardiologist and fitness expert from New Orleans, said recently in the New York Times:


“Maintaining fitness is good and maintaining low weight is good, but if you had to go off one, it looks like it’s more important to maintain your fitness than your leanness……”


So don’t get discouraged, do stay active, and don’t get too hung up on your weight if you are staying active.